Sunday, May 29, 2016

Interventions: The Screenshot

Before intervention became a household word, disseminated via television as a strategy to sober people up, therapists used it universally as any strategy designed for change.
An intervention is something a therapist uses to change behavior that doesn't work for the client. Or it might add a behavior that works much better. 
Much of therapy is about finding ways to stop something or to start something.
Here's an example, an intervention I thought up working with a client who wanted to lose weight. But  the intervention can be altered to fit any behavioral or emotional issue, too. Anything that needs reinforcement, reminders. A pretty big set. 
Just a reminder that the example below is fictitious, a variant of what really happened.

We're bemoaning the fact that at a hundred pounds overweight, the patient needs to use multiple behavioral strategies to cut down her calories, and she needs to walk every day. She does nothing but eat and sleep. The emotional reasons, the psychology, has all been discussed, purged, but the numbers on the scales still go up. Sometimes down, then up again.

Like most of us, she has a cell phone. Hers tells her when she has email.
"Can you just send me an email everyday?" she asks.
If I can't remember to call a sick friend once a month, do you really think I'll manage to do that, email you? No, this is your program, not mine.

But we come up with another idea. I print out the following, her reminder.
STOP EATING!
You want to be here to see grandchildren.
You don't want your kids to bury you in your forties. 

Print-out obesity intervention

Screenshot-obesity intervention

Then she takes a picture of the printout, and with a little effort, tries to make it a screensaver.

The Home Screen Intervention


We had to reprint it again, condense the text, make it single spaced and compact, but eventually it worked and we made it into her home screen.

Now, every time she uses her phone, the message confronts her. We're chipping away at her denial.

Time will tell, certainly, if this is going to work.

Now you have the intervention. I'm still working on what mine should say.

One thing's sure. It is cheaper than buying the many apps on the market today, and if we keep changing the words to deliberately avoid desensitization, it can't hurt, might even be, effective.

therapydoc


Thursday, May 26, 2016

1001 Ways to Live Wild

So you could have written that last post, maybe. It didn't take long. But neither of us, asked to pad the list of Eight Reasons We Overbook to 1001 Reasons We Overbook, could have made it happen. 

Who writes a list of 1001 items?

Barbara Ann Kipfer. She has a few books of lists, like 14,000 Things to Be Happy About, and 4000 Questions for Getting to Know Anyone and Everyone. She sent me the lovely little hard-covered work,  1001 Ways to Live Wild  via her publicist, published by National Geographic, which is where the truly wild things are, within those pages.

Otherwise Barbara's suggestions might have turned out to be a bit too soppy, sweet, a just do it book, rather than something truly imaginative. The book is full of tiny risk-taking strategies (although few are terribly risky) to take us out of our comfort zones, and it's good to get out of there once in awhile. We call it good stress.
Barbara Ann Kipfer quotes
Barbara Ann Kipfer quotes
Barbara Ann Kipfer quotes


I'd have to think twice, however, about recommending this list to certain patients, people who have zero get up and go, no emotional/physical energy. We would have to wait for the recovery stage, otherwise the disorder would sabotage the therapy. Therapy should sabotage a disorder, but it can work the other way around if you recommend an intervention at the wrong time. And you look inexperienced, naive.

It is not for the agoraphobic, either, until there's a possibility of getting out to a museum, or taking a walk. Without some initial help, maybe a lot, most people who can't leave the house aren't likely to hop a plane and go to Scotland. 

This is my coffee table, the place for the best books.
Therapydoc's coffee table

The list nicely satiates the topic, if you're a qualitative research person, loving that kind of thing, and reflects the author's interest in nature, geography, art, music, travel, meditation, and karma.

It is filled with joy and adventure, and if you can get some serotonin going, it can't hurt to work a few of the behavioral strategies. Take them with a good attitude and they're likely to feel pretty good. But some of them are costly, and it is presumptive to think that just anyone can travel.

Dr. Kipfer has a PhD's in linguistics, archaeology, and Buddhist studies, and reminds us that being wild can feel good, and some of our wildest moments are at our fingertips. We don't have to go to Tibet.

But consider
No. 326. Plan a trip to see as much as possible of the Colorado Trail's eight mountain ranges, six national forests, and six wilderness areas.
And if that is impossible, let me add, watch River Monsters, on Animal Planet, maybe How to Catch a Halibut. You might win a free fishing lesson, too, if you go to the website. That should wake you up.

therapydoc

Wednesday, May 25, 2016

8 Reasons We Overbook

I don't mean double book. Just packing too much in one day.

The day after promising to post daily for a week or more, my schedule is ridiculous and I think, How will I fit this in?

How does this happen? Why?

You take on new patients, that's how. And if it is a marital therapy, you probably want to see them twice that first week, not once. Maybe three times. That's how some of us do it. How one of us does it.

But it isn't only therapists who can't resist adding more to an already full workload.

Let's take a look at the reasons we over-schedule, take on more than we probably should.
Feel free to add thoughts. This is a short-list.

Why We Overdo It 

1. We can't say No.

So many reasons we can't say no.

fear of rejection,
fear someone will be angry with us,
fear we won't be included next time, will be left out,
wanting to be the go-to person
for starts.
Some see it as a weakness, call it co-dependent, others admire such strong emotional attachment.
Where would we be without people who can't say no?

2. There's an ethnic, and quintessential American world view, that it is good to get things done, to accomplish a lot.  The idle mind is the devil's playground, you know.

The thinking is that this is what being alive is all about, doing things, helping other people, providing for ourselves and our families, even having fun, or not having fun, but contributing to a community.

We burn out sometimes, we get grumpy, but it is back to it the next day, dysfunctional though it might be when the stress is too much and the spouse or kids get the brunt of it. That's a sign, you know, that the world view needs to change.

3. We LIKE being busy

There's a certain energy level that some people just have, and it has to go somewhere. We can work on subduing that, or we can go jogging, fly a kite, compulsively do dishes or clean the baseboards, whatever those are.

4. We need the money.

There's not much money in doing nothing, so most of us try to work, and get the most for the effort. Adding an extra shift, an extra patient, a second, third, or fourth part-time job, makes financial sense most of the time, pays down the credit card. It isn't greed. It is necessity.

But it can be greed. Either way, workaholics seem to think they need it.

5. We can avoid intimacy 

Too busy, too tired, both valid, great excuses. (Workaholics are often accused of this, but it isn't just people who work all of the time that we're talking about, but those of us who always have something to do, anything but take the proverbial "nap."

That's when it's about avoiding intimacy.

Part of being busy, if busy is to be functional, is fitting in time to have our needs for intimacy met, and the needs of our partners, regardless of our schedules.

There's are other posts on this blog about intimacy avoidance, check them out.  But it could be as simple as an aquarium emergency. You can't let your fish die, you know.

6. We're just getting started in this world, learning how to live

Doing is becoming, growing, adding to who we are. I'm a person who . . .
We're who we were yesterday, and today we're that person (unless we don't want to be) who identifies with a new skill, a new activity. This builds identity.

As young people we're not all encouraged to garden, or even pull weeds in the yard, for example, or to learn instruments, or learn any other hobby, thing that calls to us, makes us want to get off our duffs and do.  But then, as adults some of us get a defining moment, and suddenly, the thought of playing piano, or taking singing lessons, even going back to school or working part-time is inspiring, irresistible.

Because at any age, if we look at it right, we're just getting started.

7. There's less focus in aging

As we age, some of us find our minds wandering, wanting to do more, not less. Maybe it is because we realize we don't have that much time left, but the brain is certainly on the move. The body wants to slow down, but the mind says No. (We're ruling out a manic episode, but it feels that way.)

Work that once satisfied isn't enough, it is boring but it pays the bills, so presented with an option, for example, of saying yes to becoming, say, a member of the board, or taking on a speaking engagement, or even coaching T-ball, we say YES.
Even if, at the end of the day, we would rather eat and watch TV.

8. Multi-tasking can become addictive, especially for feel-good tasks

Some of us are gifted with the ability to multi-task, need to multitask, will plan another task even as we're busy doing something else. Some of us can do two to three things at once.

We can be at a Little League game and listen to a MLB (Major League Baseball) on our phones, and we see nothing weird about this at all. Or go to a meeting and surreptitiously check the scores. It is the pleasure principal. We do what feels good.

Take that thought, or any of the others above, add your own, and before long, you're over-booked.

Not that you don't like it that way.

So yeah, adding too many patients to the day could be due to anything. But some of us, if we commit to something, will probably get it done, manage to get everything done,  too, if not perfectly.

It is why they say:
If you want something done, give it to a busy person.
And the crazy thing is, these people don't even pat themselves on the back.

Now. Why is it that some people don't overdo it, or don't even try to accomplish very much?

It isn't, despite what your momma and papa told you, about being lazy.

therapydoc

Tuesday, May 24, 2016

The 10th Anniversary

Unbelievable that this blog has stayed alive 10 years. I've had fish that haven't lasted that long. But in all fairness, marine fish are a little on the vulnerable side. They do best when they've listened to Brene Brown's  TED Talk, The Power of Vulnerability.

Not that I haven't always encouraged them to express themselves, to be authentic, above all.
Watchman Gobi, a little nervous

The blog, for all its longevity, suffers from Attention Deficit Disorder. I've tested it, and it is obvious that it rarely stays on one topic for longer than a day. We jump all over the place in this spot, from birth to death, order to disorder, to food, hobbies, conferences air travel, anywhere this anonymous blogger has traveled to lately, and always, always, we discuss relationships of all kinds.

It can be a chore though.  So why not experiment for a week, maybe two, assuming the experimenter can go that long. We're going to try to beat the ADD.

A snapshot a day for two weeks, not counting Saturday and Sunday. You can use those days to catch watch some baseball.

If you subscribe to this blog by email, your mailbox will be glutted, so feel free, delete right away. You know how to find this place.

But don't unsubscribe. Because the chances are excellent that I'll quit and go back to writing once or twice a month. ,

Anyway, this is the lineup for the next few hopefully short posts:

Insanity in High School, (because it used to be college, see, now it is high school)
1000 Ways to Live Wild, (it's a book)
a peak at psychologist-starring television shows like IN TREATMENT and The Bob Newhart Show,
Chuck Lorre's Vanity Cards,
and Transgenerational Addiction, brought to life by the television show MOM.

Can this be done?

Probably not.

Talk to you tomorrow.

therapydoc






Sunday, May 08, 2016

Snapshots: Mothers Day

Is it, Mothers Day, or Mother's Day?

(1) Gold-Cross

Anyone who has ever been to therapy, or who is psychologically astute, understands that emotional states can be triggered by holidays, by birthdays, and anniversaries.

It is because we're encouraged to remember these days, and the very mention of the date on the calendar, signals brain retrieval, all that is associated with that date, whatever is within reach. So on your brother's birthday, if you forgot it before, you'll remember it when you write a check with that date. The anniversary of your first marriage will give you pause.
Heinrich Bavarian Gold-Cross crystal, right, 

And marketing is ubiquitous. The approach of Mother's Day is a harbinger to remember Mom. Buy her something. What if it were just a day of remembrance, the living and those who are gone, no buying anyone anything, or even, having to remember to give cards?

Things from boxes, put them in the dishwasher right away
I don’t remember last year, or the year before, but Mother’s Day crept up on me last week, and it hasn’t really let go. This will be the third since mine passed away, and everything reminds me of her, as if it were the first year. 

In the first year following her death, no matter what anyone said, no matter what I saw on TV, or what was in the news, or what anyone told me at work or anywhere else, it reminded me of her. 

This year, in April, with a little time off, I ventured into the basement and opened boxes, wondered where I should put those things inside, who should get what, who would appreciate the possessions she chose to buy, that she held in her hands. Who would use them? 

It didn't even occur to me, in those moments, that in a few weeks television ads would glut our personal space with reminders that we should buy presents, or give presents to other moms, maybe a daughter-in-law, an aunt, a daughter, a friend. It was as much as I could do, open boxes, and all of it, unconscious.

She had Bavarian gold-cross china, with a simple black and gold-cross rim pattern, elegant, not ungapatched (sounds like oohn, gah, patcht, Yiddish, means busy, cluttered, overly ornate, not her). 

A woman grows up, as she would say, poor as a church mouse, works with her husband in their family retail china, silverware, and crystal business, surrounded with beautiful things every day on the job. She can get anything she wants wholesale or at cost, and chooses not Wedgewood, not Royal Doulton, not Lenox or Oxford, but a simple, elegant German pattern. 

In the hospital she mentions it, Who will get my china when I die, my good china, the gold-cross? A nurse hears her and says, If no one else wants it, I'll take it.  

Yeah, right.

(2) Being Angry on Mother's Day

I hosted a little family luncheon on Saturday, and my grandchildren seemed more interested in the adult chatter than usual. When you host you are a few degrees of separation apart from the conversation, so you watch more than listen, and it surprised me, as it always does, how tall my mother's great-grandsons had grown. My father would have been proud of their looks, and certainly their height, but my mother would have loved their solicitousness, the way they tend to hover around older people, not to help, truth be told, but to see what we have to offer.  It isn't only the cookies in the cookie jar my grandsons are into, but advice on things, mostly hobbies. I have an indoor garden. FD likes to fish. I have a marine aquarium. Kids are fascinated about such things.

They would have loved their great-grandmother, my mom, I tell them, both of my parents. Their memories of them have surely faded by now, mostly visits in a stroller to the senior residence, finding processed chocolate pudding in the refrigerator, making a mess, as pre-kindergarteners will do, Mom telling me, It's fine, don't worry about it, I'll clean up later. This, my obsessive compulsive mother.

Thinking about their loss, and hers, my eyes narrow with anger that she isn't with us, isn't at the table.

Returning to the group from the kitchen, I sit down, remark, thinking no one hears me, I wish there were no Mother's Day. I wish nobody had invented it.

Surprise, almost everyone does hear it.

And they ask, a little shocked, Why?

And I say, It just makes me so angry that she missed all of this, missed your successes and frustrations (she would have listened), missed seeing two of of her grandchildren marry beautiful people, missed watching the great-grandchildren grow out of babydom

Then my daughter says, If I ever have a girl, I'll name her ____. (My mother's name).

And a son: Oh, man. I miss her, too.

Then somehow we launch into the topic of meat, and how she had a way with food, never over or under-cooking it, and I tell them that when she and my father would come home from work late, 6-6:30, I was the one who had cooked for them, and I couldn't have been older than fourteen, which sounded right to me, until I looked at my almost fourteen year-old grandson and pictured him manning the broiler.

And the anger passed, for awhile.

But you know what it's like.

Happy Mother's Day, friends.

therapydoc

Waterford-crystal: perhaps not so simple